Abstract
The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown. To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA. Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18-75 years) with a first PES contact in 2010-2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period. We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission. We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.
Highlights
The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown
During a 7-year follow-up period, a retrospective Taiwanese study in patients with schizophrenia found a frequency of repeated compulsory psychiatric admissions of 5.5%, and that the risk of compulsory readmission was higher in patients with a prior compulsory admission than in those whose prior admission had been voluntary (adjusted hazard ratio (HR) = 1.31)
A prospective study in Switzerland with a 24-month follow-up period found a frequency of repeated compulsory psychiatric admissions of 36% and that two factors were associated with such admissions: previous compulsory admission – especially when it had been because of endangerment of others – and a diagnosis on the psychosis spectrum
Summary
Compulsory psychiatric admissions are very stressful events in the lives of patients and their caregivers. A recent systematic review stated that the greatest risks for such admissions were associated with previous involuntary admissions to hospital and a diagnosis of a psychotic disorder, and to a lesser extent with being male, single and unemployed, receiving welfare benefits and having a diagnosis of bipolar disorder. The unfortunate fact that many patients undergo repeated compulsory admissions, is indicative of a need to develop targeted interventions. Most of the little research that has been done on ‘revolving-door’ patients has focused on voluntary admissions.3–7 It found four predictors of frequent readmissions: a history of previous psychiatric admissions, a diagnosis on the psychosis spectrum, being unemployed and living in residential accommodation. A prospective study in Switzerland with a 24-month follow-up period found a frequency of repeated compulsory psychiatric admissions of 36% and that two factors were associated with such admissions: previous compulsory admission – especially when it had been because of endangerment of others – and a diagnosis on the psychosis spectrum.. One important reason for performing these studies is to identify risk factors that may be modifiable targets for interventions intended to reduce repeated compulsory psychiatric admissions. Our specific aims were to investigate the following: the frequency of repeated ECPAs; the associations between clinical, demographic and process factors and the risk of repeated ECPA; and the associations between these same factors and the time to compulsory readmission
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